# Are there racial/ethnic differences in antibiotic treatment of community acquired pneumonia in the inpatient setting?

## TL;DR

The study found that non-Hispanic Black patients were more likely to receive appropriate antibiotic treatment for pneumonia in hospitals compared to non-Hispanic White patients, but treatment varied by hospital size and region.

## Contribution

The study identifies racial/ethnic disparities in antibiotic treatment for pneumonia and hospital-level factors influencing treatment consistency.

## Key findings

- Non-Hispanic Black patients had higher odds of receiving guideline-concordant antibiotic therapy compared to non-Hispanic White patients.
- Larger hospitals and those in the South and Northeast were less likely to provide guideline-concordant care.
- No significant link was found between treatment disparities and clinical outcomes.

## Abstract

Community Acquired Pneumonia (CAP) is the most common reason for antibiotic treatment in hospitalized adults. Some prior studies have found treatment differences by race/ethnicity, but research on the topic is limited, results are mixed, and it is unclear if clinical outcomes are affected.

We conducted a retrospective analysis of hospitalized patients >=18 years of age with a diagnosis of CAP from 2018–2021 across 457 US hospitals in the Vizient Inc. Clinical Data Base. We examined guideline concordant antibiotic treatment differences for inpatient CAP by patient race/ethnicity and hospital level factors and secondarily assessed whether treatment differences affect patient clinical outcomes.

There were 1,277,770 admissions. Over half of all patients received concordant antibiotic therapy. Non-Hispanic Black patients had an increased odds of receiving guideline concordant antibiotic care (OR 1.22 95% CI 1.21–1.23) compared to non-Hispanic White patients. As the number of hospital beds increased, the odds of receiving concordant therapy decreased, with the greatest reduced odds between hospitals with >500 beds vs < 75 beds (OR 0.68, 95% CI 0.66–0.70). As case mix index increased concordant care decreased with the lowest odds observed at hospitals with a case mix index >2 (OR 0.71 95% CI 0.7–0.72). Patients at hospitals in the South (OR 0.8 95% CI 0.79–0.81) and Northeast (OR 0.71, 95% CI 0.7–0.72) were less likely than those in the West to receive concordant care. There was no significant association between the interaction of race/ethnicity and receipt of guideline concordant therapy and clinical outcomes.

Non-Hispanic Black patients were more likely to received guideline-concordant care for CAP however significant differences in concordant therapy were seen at the hospital level. Understanding the interplay of race/ethnicity and concordant CAP therapy at the individual and population level is important for future research in the examination of disparities in care.